Quality statement 6: Assessing physical health

Quality statement

Adults with psychosis or schizophrenia have specific comprehensive physical health assessments.

Rationale

Life expectancy for adults with psychosis or schizophrenia is between 15 and 20 years less than for people in the general population. This may be because people with psychosis or schizophrenia often have physical health problems, including cardiovascular and metabolic disorders, such as type 2 diabetes, that can be exacerbated by the use of antipsychotics. Comprehensively assessing physical health will enable health and social care practitioners to offer physical health interventions if necessary.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with psychosis or schizophrenia receive comprehensive physical health assessments.

Data source: Local data collection.

Process

a) Proportion of adults having treatment for first episode of psychosis who receive a comprehensive physical health assessment within 12 weeks.

Numerator – the number in the denominator who receive a comprehensive physical health assessment within 12 weeks.

Denominator – the number of adults having treatment for a first episode of psychosis.

Data source: Local data collection. Data can be collected using NHS England's Commissioning for Quality Innovation (CQUIN) indicator Improving physical healthcare to reduce premature mortality in people with severe mental illness, indicator 1 and the Royal College of Psychiatrists' National audit of schizophrenia Audit of practice tool, questions 30 to 39.

b) Proportion of adults having treatment for first episode of psychosis who have a comprehensive physical health assessment 1 year after starting treatment.

Numerator – the number in the denominator who have a comprehensive physical health assessment 1 year after starting treatment.

Denominator – the number of adults having treatment for a first episode of psychosis.

Data source: Local data collection. Data can be collected using NHS England's Commissioning for Quality Innovation (CQUIN) indicator Improving physical healthcare to reduce premature mortality in people with severe mental illness, indicator 1 and the Royal College of Psychiatrists' National audit of schizophrenia Audit of practice tool, questions 30 to 39.

c) Proportion of adults with psychosis and schizophrenia who have an annual comprehensive physical health assessment.

Numerator – the number in the denominator who have an annual comprehensive physical health assessment.

Denominator – the number of adults with psychosis or schizophrenia.

Data source: Local data collection. Data can be collected using NICE Quality and Outcomes Framework menu indicators NM15, NM16, NM17, NM18 and NM42.

Outcome

Premature mortality of adults with psychosis or schizophrenia.

Data source: Local data collection. Contained within the NHS outcomes framework.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (such as GPs, community health services and mental health services) ensure that protocols are in place to carry out comprehensive physical health assessments in adults with psychosis or schizophrenia, and share the results (under shared care arrangements) when the service user is in the care of primary and secondary services.

Health and social care practitioners ensure that they carry out comprehensive physical health assessments in adults with psychosis or schizophrenia, and share the results (under shared care arrangements) when the service user is in the care of primary and secondary services.

Commissioners (such as NHS England local area teams and local authorities) ensure that they commission services that can demonstrate they are carrying out comprehensive physical health assessments in adults with psychosis or schizophrenia, and include this requirement in continuous training programmes. They should also ensure that shared care arrangements are in place when the service user is in the care of primary and secondary services, to ensure that the results of assessments are shared.

What the quality statement means for patients, service users and carers

Adults with psychosis or schizophrenia should have a regular health check (at least once a year) that includes taking weight, waist, pulse and blood pressure measurements and blood tests. This checks for problems such as weight gain, diabetes, and heart, lung and breathing problems that are common in adults with psychosis or schizophrenia and often related to treatment. The results should be shared between their GP surgery and mental health team.

Source guidance

Definitions of terms used in this quality statement

Comprehensive physical health assessments

Comprehensive physical health assessments for adults with psychosis or schizophrenia should focus on physical health problems common in people with psychosis and schizophrenia by monitoring the following:

  • weight (plotted on a chart) – weekly for the first 6 weeks, then at 12 weeks, at 1 year and then annually

  • waist circumference annually (plotted on a chart)

  • pulse and blood pressure at 12 weeks, at 1 year and then annually

  • fasting blood glucose, HbA1c and blood lipid levels at 12 weeks, at 1 year and then annually

  • overall physical health.

Interventions should be offered in line with NICE guidelines on lipid modification, preventing type 2 diabetes, obesity, hypertension, prevention of cardiovascular disease and physical activity. [Adapted from Psychosis and schizophrenia in adults (NICE guideline CG178) recommendations 1.1.3.2, 1.5.3.2 and 1.5.3.3]

Shared care arrangements

Secondary care teams should assess the service user's physical health and the effects of antipsychotic medication for at least the first 12 months or until the person's condition has stabilised, whichever is longer. Thereafter, assessments may be transferred to primary care under shared care arrangements and should take place at least annually. Service users may no longer be under the care of shared care arrangements if they are discharged from secondary care services [Adapted from Psychosis and schizophrenia in adults (NICE guideline CG178) recommendation 1.3.6.5]